Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 101418 | MN |
NPI | 1205932258 |
---|---|
Provider Name | Tonya Benzie |
First Address | Duluth, MN 55805-2433 |
Second Address | Duluth, MN 55805-2433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
260T6BE | BCBS MN INDIVIDUAL (01) | MN |
40852900 | (05) | WI |
6403495 | MN MEDICA INDIVIDUAL (01) | FM |